Centers for Disease Control and Prevention

National Center for Immunization and Respiratory Diseases

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Recommendations from the Combined Immunization 

Schedule WG for the 2022 Immunization Schedules for 

Children/Adolescents and Adults 

Kevin Ault, MD (ACIP Combined Immunization WG Chair)

A. Patricia Wodi, MD (CDC Co-Lead)

Neil Murthy, MD, MPH, MSJ (CDC Co-Lead)

ACIP Meeting

November 3, 2021
 The Combined Immunization Schedule WG updates the child/adolescent 

and adult immunization schedules annually.

– Child/adolescent immunization schedule: recommendations for persons 18 years 

of age or younger

– Adult immunization schedule: recommendations for persons 19 years of age or 

older

 The goal of the Combined Immunization Schedule WG is to better 

harmonize the child/adolescent and adult schedules.

Combined Immunization Schedules Work Group

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Thank You

Henry Bernstein, DO, MHCM, FAAP

ACIP Term: 11/27/2017-6/30/2021

Professor, Donald and Barbara Zucker 

School of Medicine at Hofstra/Northwell 

Cohen Children’s Medical Center

New Hyde Park, NY

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Welcome

Sybil Cineas, MD, FAAP, FACP,

ACIP Term: 7/28/2021 – 6/30/2025

Associate Professor of Medicine, Pediatrics, 

and Medical Science 

Associate Program Director, Brown Combined 

Residency in Internal Medicine and Pediatrics

The Warren Alpert Medical School of Brown 

University, Providence, RI. 

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ACIP Members

Kevin Ault (ACIP WG Chair)

Veronica McNally

Sybil Cineas

Liaison Representatives

John Epling (AAFP) Susan Lett (CSTE)

Sarah Coles (AAFP) Chad Rittle (ANA)

Katherine Debiec (ACOG) William Schafner (NFIP)

Rhoda Sperling (ACOG) Ken Schmader (AGS)

Holly Fontenot (SAHM) Patsy Stinchfield (NAPNAP)

Amy Middleman (SAHM) Marci Drees (SHEA)

Sandra Fryhofer (ACP/AMA) Sean O’Leary (AAP)

Sarah McQueen (AAPA) Molly Howell (AIM)

Marie-Michele Leger (AAPA)

Ex Officios

David Kim (OASH)

Sean Dade (OASH)

Jane Kim (DVA)

Thomas Weiser (IHS)

Uzo Chukwuma (HIS)

Consultants

Hank Bernstein 

Paul Hunter 

Peter Szilagyi

Diane Peterson

Carolyn Bridges

Karen Ketner

Kathleen Harriman

Litjen Tan

Robert Hopkins

Combined Immunization Schedule Work Group 2021

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CDC Co-Leads

A. Patricia Wodi

Neil Murthy
 ACIP Combined Immunization Work Group — CDC Contributors:

– Priti Patel

– Ram Koppaka

– Sara Oliver

– Sarah Mbaeyi

– Sarah Schillie

– Susan Hariri

– Suzanne Johnson-DeLeon

– Tamara Pilishvili

– Tara Anderson

– Tara Jatlaoui

– Tatiana Lanzieri

Acknowledgements

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– Aaron Harris

– Akiko Wilson

– Amy Parker Fiebelkorn

– Andrew Kroger

– Anna Acosta

– Elissa Meites

– Fiona Havers

– Gabriela Paz-Bailey

– Hilda Razzaghi

– Holly Hill

– Janell Routh

– JoEllen Wolicki

– Kathleen Dooling

– Kathy Byrd

– Lauri Markowitz

– Lisa Grohskopf

– Lucy McNamara

– Margaret Cortese

– Mark Freedman

– Mark Weng

– Miwako Kobayashi

– Mona Marin

– Noele Nelson

– Paul Gastanaduy
 The use of vaccine trade names is for identification purposes only and 

does not imply endorsement by the Centers for Disease Control and 

Prevention.

 The 2022 schedules presented in the following slides are drafts and are 

therefore subject to change based on ACIP’s discussion and vote.

Disclaimer

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 ACIP approval of the proposed schedules is necessary prior to publication in 

Morbidity and Mortality Weekly Report in February 2022.

 The following professional societies also approve the schedules prior to the 

2022 publications

– American Academy of Pediatrics (AAP) – only child/adolescent schedule 

– American College of physicians (ACP) – only adult schedule

– American Academy of Family Physicians (AAFP)

– American College of Obstetricians and Gynecologists (ACOG)

– American College of Nurse-Midwives (ACNM)

– National Association of Pediatric Nurse Practitioners (NAPNAP) – only child/adolescent 

schedule 

– American Academy of Physician Assistants (AAPA)

– Society for Healthcare Epidemiology of America (SHEA) – only adult schedule

 New policies are not established in the proposed schedules.

– Annual schedules reflect recommendations already approved by ACIP

Reason Topic is Being Presented to ACIP

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 Harmonization between the child/adolescent and adult schedules

 Edits to all tables

 Content changes of the notes

 New appendix listing contraindications and precautions

 Discussion and Vote

Outline

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2022 Child and Adolescent Immunization Schedule 

Dr. A. Patricia Wodi
ACIP Votes since October 2020

– Dengue vaccination (ACIP vote June 2021)

• Use of dengue vaccine in ages 9–16 years in endemic areas

– Influenza vaccination (ACIP vote June 2021; MMWR August 2021)

• 2021–22 Influenza vaccine recommendations

• Minimum age for cell culture–based inactivated influenza vaccine

• Contraindications and precautions for influenza vaccines

 Edits to tables and notes of other vaccines for clarity

Appendix listing contraindications and precautions for 

vaccine types

Child and Adolescent Immunization Schedule: 2022 updates

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 Changes to Tables – Cover Page – Table 1, 2 and 3  Changes to Vaccination Notes – COVID-19 – Dengue – Hib – Hepatitis A – Hepatitis B – Human Papillomavirus – Influenza – Measles, Mumps and Rubella – Meningococcal – Varicella  Appendix 

Overview of Proposed Updates 

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COVID-19 vaccines are recommended for use within the scope of

the Emergency Use Authorization or Biologics License Application

for the particular vaccine, or as otherwise recommended by ACIP

and adopted by the CDC director. ACIP recommendations for the

use of COVID-19 vaccines can be found at

www.cdc.gov/vaccines/hcp/acip-recs/index.html.

CDC’s interim clinical considerations for use of COVID-19 vaccines

can be found at www.cdc.gov/vaccines/covid-19/clinicalconsiderations/covid-19-vaccines-us.html.
33

Routine vaccination • Age 9–16 years living in dengue 

endemic areas AND have 

laboratory confirmation of 

previous dengue infection ─ 3-dose series administered at 

0, 6, and 12 months 

• Endemic areas include Puerto 

Rico, American Samoa, US Virgin 

Islands, Federated States of 

Micronesia, Republic of Marshall 

Islands, and the Republic of Palau. 

For updated guidance on dengue 

endemic areas and pre-

vaccination laboratory testing
34

Catch-up vaccination 

Revised bullet: • For other catch

-up guidance, see Table 2. Vaxelis can 

be used for catch-up vaccination in children less than 

age 5 years. Follow the catch-up schedule even if 

Vaxelis is used for one or more doses. For detailed 

information on use of Vaxelis see 

www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm

Routine vaccination 

Revised bullets • ActHIB, Hiberix, Pentacel, or Vaxelis: 

4-

dose series [3 dose primary series at age 2, 

4, and 6 months, followed by a booster 

dose* at age 12–15 months] 

─ *Vaxelis is not recommended for use as a 

booster dose. A different Hib-containing 

vaccine should be used for the booster 

dose. 

• PedvaxHIB: 3-dose series [2-dose primary 

series at age 2 and 4 months, followed by a 

booster dose at age 12–15 months]
35

Routine vaccination 

• Revised bullet: 2-dose series 

(minimum interval: 6 months) 

at age 12–23 months
36

Special situations

• Revised bullet: Post-vaccination serology 

testing and revaccination

(if anti-HBs < 10mlU/mL) is recommended for 

certain populations, including: 

-Infants born to HBsAg-positive mothers 

-Hemodialysis patients 

-Other immunocompromised persons 

For detailed revaccination recommendations, see 

www.cdc.gov/vaccines/hcp/acip-recs/vaccspecific/hepb.html.
37

Routine and catch-up vaccination

• Revised bullet: No additional dose recommended when 

any HPV vaccine series has been completed using the 

recommended dosing intervals.

Special situations 

• Revised bullet: Immunocompromising conditions, 

including HIV infection: 3-dose series regardless of age 

at initial vaccination

• Revised bullet: Pregnancy: Pregnancy testing not 

needed before vaccination; HPV vaccination not 

recommended until after pregnancy; no intervention 

needed if vaccinated while pregnant
38

Special situations • Revised bullet: Egg allergy with symptoms other than hives (e.g., 

angioedema, respiratory distress) or required epinephrine or another 

emergency medical intervention: see Appendix listing contraindications and 

precautions

• Revised bullet: Severe allergic reaction (e.g., anaphylaxis) to a vaccine 

component or a previous dose of any influenza vaccine: see Appendix listing 

contraindications and precautions

Deleted bullets: • Severe allergic reactions to vaccines can occur even in the absence of a 

history of previous allergic reaction. All vaccination providers should be 

familiar with the office emergency plan and certified in cardiopulmonary 

resuscitation.

• LAIV4 should not be used in persons with the following conditions or 

situations:
39

Routine vaccination

• Added bullet: MMR or MMRV may be 

administered*

• Added: *Note: For dose 1 in children 

age 12–47 months, it is recommended 

to administer MMR and varicella 

vaccines separately. MMRV may be 

used if parents or caregivers express a 

preference.

Catch-up vaccination

• Added bullet: Minimum interval 

between MMRV doses: 3 months
40

Special situations

Revised note: Menactra should be 

administered either before or at the same 

time as DTaP. MenACWY vaccines may be 

administered simultaneously with MenB

vaccines if indicated, but at a different 

anatomic site, if feasible.
41

Routine vaccination • Added bullet: VAR or MMRV may be administered* • Added: *Note: For dose 1 in children age 12–47 months, 

it is recommended to administer MMR and varicella 

vaccines separately. MMRV may be used if parents or 

caregivers express a preference.

• Revised bullet: Dose 2 may be administered as early as 3 

months after dose 1 (a dose inadvertently administered 

after at least 4 weeks may be counted as valid) 

Catch-up vaccination

• Revised bullet: Age 7–12 years: routine interval: 3 months 

(a dose inadvertently administered after at least 4 weeks 

may be counted as valid)

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For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Thank You! 

Questions?
2022 Adult Immunization Schedule 

LCDR Neil Murthy, US Public Health Service
 Changes to Tables

– Cover Page

– Table 1

– Table 2

 Changes to Vaccination Notes

– COVID-19

– Hepatitis B

– Human Papillomavirus

– Influenza

– Measles, Mumps and Rubella

– Meningococcal 

– Pneumococcal

– Varicella

– Zoster

 Addition of Appendix

Proposed Updates to the 2022 Adult Immunization Schedule 

48
 Changes to Tables

– Cover Page

– Table 1

– Table 2

 Changes to Vaccination Notes

– COVID-19

– Hepatitis B

– Human Papillomavirus

– Influenza

– Measles, Mumps and Rubella

– Meningococcal 

– Pneumococcal

– Varicella

– Zoster

 Addition of Appendix

Proposed Updates to the 2022 Adult Immunization Schedule 

49
 Changes to Tables

– Cover Page

– Table 1

– Table 2

 Changes to Vaccination Notes

– COVID-19

– Hepatitis B

– Human Papillomavirus

– Influenza

– Measles, Mumps and Rubella

– Meningococcal 

– Pneumococcal

– Varicella

– Zoster

 Addition of Appendix

Proposed Updates to the 2022 Adult Immunization Schedule 

50
 Changes to Tables

– Cover Page

– Table 1

– Table 2

 Changes to Vaccination Notes

– COVID-19

– Hepatitis B

– Human Papillomavirus

– Influenza

– Measles, Mumps and Rubella

– Meningococcal 

– Pneumococcal

– Varicella

– Zoster

 Addition of Appendix

Proposed Updates to the 2022 Adult Immunization Schedule 

51
Cover Page










Table One

The Recommended Adult Immunization Schedule







Table 2 

The Medical Indications Table




Reworded: “Contraindicated or not recommended”






Notes
Page 1
Page 1
Page 1
COVID-19 Vaccination:

• Added the phrase: “or as otherwise 

recommended by ACIP and adopted 

by the CDC director.”

Page 1
Page 1

COVID-19 Vaccination:

• Added the link to the Interim Clinical 

Considerations for use of COVID-19 

vaccines
Page 1
Routine vaccination:

• Clarification of 2, 3, and 4 dose 

series

Removed “Special situations” section, 

in anticipation of the universal 

vaccination recommendation.

Page 1
Page 1
Routine vaccination

• Changed wording for clarity: No additional dose 

recommended when any HPV vaccine series has 

been completed using the recommended 

dosing intervals.

Page 1
Special situations

• Added wording to “Immunocompromising 

Conditions” for clarity: 3-dose series as above, 

when initiating vaccination at age 9–45 years. 

Recommendations for routine and shared 

clinical decision-making similar to those for 

persons without immunocompromising 

conditions.

Page 1
Special situations

• Rearranged the wording for the “pregnancy” 

bullet: Pregnancy testing is not needed before 

vaccination; HPV vaccination is not 

recommended until after pregnancy; no 

intervention needed if inadvertently vaccinated 

while pregnant.

Page 1
Page 1
Routine vaccination

• Changed language: Age 19 years or older

Page 1
Routine vaccination

• Added hyperlink to the 2021-2022 influenza 

recommendations and a bullet for the 2022-

2023 influenza recommendations.

Page 1
Page 2
Page 2
Page 2

Special Situations

• Condensed this section. Refer health care 

providers to the Appendix for more information 

on contraindications and precautions.
Page 2
Page 2

Special Situations

• Added CD4 percentages in addition to CD4 

counts for HIV infection (to harmonize 

language with child/adolescent schedule)
Page 2
Page 2

Added note at end of section stating: 

“MenB vaccines may be administered 

simultaneously with MenACWY

vaccines if indicated, but at a 

different anatomic site, if feasible.”
Page 3
Page 3
Page 3

Routine vaccination

• Changed language to reflect the new recommendations: “Age 65 

years or older who have not previously received a pneumococcal 

conjugate vaccine or whose previous vaccination history is 

unknown: 1 dose PCV15 or 1 dose PCV20. If PCV15 is used, this 

should be followed by a dose of PPSV23.”
Page 3

Routine vaccination

• Added language regarding dosing interval: “For dosing interval 

between PCV15 and PPSV23, see URL pending.”
Page 3

Routine vaccination

• Added bullet on guidance for patients who have previously 

received PCV13 and/or PPSV23.
Page 3

Special situations

• Changed language to reflect the new recommendations: “Age 19–

64 years with certain underlying medical conditions or other risk 

factors who have not previously received a pneumococcal 

conjugate vaccine or whose previous vaccination history is 

unknown: 1 dose PCV15 or 1 dose PCV20. If PCV15 is used, this 

should be followed by a dose of PPSV23.”
Page 3

Special situations

• Added language regarding dosing interval: “For dosing interval 

between PCV15 and PPSV23, see URL pending.”
Page 3

Special situations

• Added bullet on guidance for patients who have previously 

received PCV13 and/or PPSV23.
Page 3

Added note at end of section stating: “Underlying medical conditions or 

other risk factors include alcoholism, chronic heart/liver/lung disease, 

cigarette smoking, diabetes mellitus, chronic renal failure, nephrotic 

syndrome, immunodeficiency, iatrogenic immunosuppression, 

generalized malignancy, HIV, Hodgkin disease, leukemia, lymphoma, 

multiple myeloma, solid organ transplants, congenital or acquired 

asplenia, sickle cell disease or other hemoglobinopathies, CSF leak, or 

cochlear implant.”
Page 3
Page 3

Special Situations

• Added CD4 percentages in 

addition to CD4 counts for HIV 

infection (to harmonize language 

with child/adolescent schedule)
Page 3
Page 3

Special Situations • Revised the language for the pregnancy bullet: “There is currently no ACIP recommendation for 

RZV use in pregnancy. Consider delaying RZV until 

after pregnancy.”
Page 3

Special Situations

• Added language to reflect the new recommendations 

for immunocompromising conditions: “RZV 

recommended for use in persons age 19 years or 

older who are or will be immunodeficient or 

immunosuppressed due to disease or therapy.”










For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Thank You! 

Questions?
Back-up slides
2021 Child/Adolescent Immunization Schedule








2021 Adult Immunization Schedule